Thousands of spine procedures are performed daily in the United States and around the world. Many of these procedures involve removal of the disc material in preparation for either fusion or replacement of the disc. Meticulous disc space preparation is required for either fusion or disc replacement, and this task is invariably laborious and is often performed sub-optimally.
The variety of disc surgical procedures is rapidly increasing, keeping abreast with the progress of technology. Disc excision usually involves removal of the extruded nucleus material as well as the nuclear material lying loosely in the disc space. Partial disc replacements are in the early stages of evolution and involve variable amounts of nuclear material. Total disc replacements and fusion of the disc space involve removal of the nucleus, some annular material posteriorly, and the endplates to facilitate bonding of the prosthetic disc to the host bone, in the case of the disc replacement and incorporation of the bone graft, in the case of fusion. While it is possible to remove the endplates in a reproducible fashion through the open anterior approach, it is difficult to quantify the completeness of the disc excision through the posterior and transforaminal approaches. At this time there is no effective way of thoroughly excising the disc and preparing the end-plate through the least invasive approaches, such as the arthroscopic approach, for disc replacement or fusion.
It would be desirable to address the quality of disc removal and endplate preparation, while minimizing the trauma of surgery, minimizing blood loss, and markedly reducing surgical time.